Provider First Line Business Practice Location Address:
3184 W 111TH PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90303-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-812-0788
Provider Business Practice Location Address Fax Number:
213-403-4171
Provider Enumeration Date:
09/10/2024